Surgical Retractors are used to hold an incision or wound open while a surgeon works. The retractor could also be used to hold tissues or organs out of the way during a surgery.
Self-retaining retractors allow hands free operation during a surgery. Self-retaining surgical retractors like the Galaxy II can be small, such as those for eye procedures, or large, such as table mounted retractor systems.
Weitlaner and Gelpie Retractors are two of the most commonly used self-retaining retractors for abdominal surgery, but there is also Balfour and Bookwalter Retractors (can be table mounted), as well as Goligher Retractor and Iron Intern.
This instructional video demonstrates set up and utilization of the vaginal self-retaining retractor for pelvic surgery. This includes review of all the component parts, step-by-step assembly, and utilization in different surgical scenarios. This retractor can be easily used with an improved understanding of function and set up; this video aims to aid with both. Utilization of a vaginal retractor facilitates surgical exposure of the pelvis. It also allows the surgeon to operate without reliance on variable surgical assistants. Finally, it promotes surgeon ergonomics.
Manual retraction, a task performed to expose the surgical site, poses a high risk for musculoskeletal disorders that affect the hands, arms, shoulders, neck, and back. In recent years, minimally invasive and laparoscopic procedures have led to the development of multifunctional instruments and retractors capable of performing these functions that, in many cases, has eliminated the need for manual retraction.
During surgical procedures that are not performed endoscopically, the use of self-retaining retractors enables the assistant to handle tissue and use exposure techniques that do not require prolonged manual retraction.
Tissue Retraction in the Perioperative Setting provides an algorithm for perioperative care providers to determine when and under what circumstances manual retraction of tissue is safe and when the use of a self-retaining retractor should be considered.
Benefits of surgical self-retaining retractors:
· Surgical retractors free up the hands of an assistant
· Improved access to surgical site
· Single handed adjustments (in newer models)
· Less instrument clutter at the incision
· Light-weight and easy to use (newer models)
· Fewer staff in operating room
· Great visual access for students
There is plenty of evidence that fewer staff in the operating room/theatre has a positive effect by reducing infection risk. By replacing the number of individuals close to the open wound, the risk of contamination both from staff to patient as well as from patient to staff is improved. With Covid-19 now present in our every day lives, of course there is now further benefits to using surgical retractors instead of assistants in very close proximity having to lean in close in often awkward positions to assist for long period of times.
These types of self-retaining retractors have locking mechanisms that keep the blades apart and in place while spreading the edges of the incision and holding other tissue in place, thus freeing the surgeon's and assistant's hands for other tasks.
Weitlaner and Gelpie
Two of the most commonly used self-retaining retractors are the Weitlaner and Gelpie retractors. These are used to retract skin edges for superficial procedures. Care must be taken not to puncture vital tissues or oneself with the sharp points of these retractors.
Balfour and Bookwalter
The Balfour and the Bookwalter are self-retaining abdominal wall retractors with various deep and shallow blades that can be attached and removed as needed. The Balfour retractor is placed within the incision, spread apart as needed, and locked in place by tightening of a wing nut. The Bookwalter retractor has a single post that attaches to the table's side rail. This attachment takes some practice to master. A crossbar mounted on the post holds an oval or round ring to which various sizes of Richardson, malleable, and Deaver-like blades may be attached with adjustable, ratcheted “clips.”
Goligher and Iron Intern
The Goligher retractor is used for abdominal operations in the superior regions of the peritoneal cavity, particularly for gallbladder, liver, and stomach procedures. It is easily attached to a crossbar placed onto the head of the OR table. The Iron Intern uses a series of locking arms and joints to position retractors within the abdomen or pelvis.
Galaxy II 3 finger claw: JUNE3005B-50 (box of 50 single packed)
These types are particularly useful in urology, gynecology, ENT, orthopedics, plastic surgery, and many other procedures that need 360 degrees access and vision.
Systems with screw or wire mechanism:
Systems with new cam lock mechanism:
Retractor frames can be re-usable or single use, and are used with single use hooks of different types. The most common hooks are 5mm sharp or blunt hooks or in some cases 12mm blunt hooks for some procedures.
Unique cam locks for single hand adjustments only available in Galaxy II™
Switching to single-use self-retaining surgical retractors reduces the risk of patient-to-patient cross-contamination as well as saving the time and cost involved in reprocessing.The traditional alternative to single-use kits is reusable instruments, which by their very nature have inherent risks when it comes to infection of patients.
Reusable instruments can be perceived to offer false economies to healthcare practitioners and health institutions as a result of these risks.
There is significant knock-on implications in terms of cost, patient safety and recovery time.
Reusable medical instruments also pose inherent concerns regarding their maintenance, storage and repeated use, all of which are often exacerbated by reprocessing and sterilisation procedures. For surgical self-retaining retractors, it is only the frame that could be reprocessed (not the stay hooks which would always be single use due to infection risk), and with the low cost of the Galaxy II frame (despite being manufactured in the UK), the perceived cost saving in reusable metal retractors are virtually none once purchase cost, manual handling, storage, washing, sterilising and transport has been factored in.
Many surgical instrument failures occur as a result of healthcare practitioners failing to follow manufacturers’ reprocessing and handling instructions.
Common errors include, but are not limited to:
Single-use instruments are designed to be cost-effective, safe and ready to use at the point of care.
Question: Can Galaxy II frames be re-sterilised?
Answer: No, they come sterile, and are single use only.